Active NPI
Diana Zardouz
- Dentist
- Huntington Beach, CA
National Provider Identifier
1245572619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62577
- Practice address
- 18377 Beach Blvd Ste 106B
Huntington Beach, CA 92648-1349 - Phone
- (714) 847-8660
- NPI assigned
- Mar 22, 2013
- Reactivated
- Feb 11, 2014
- Last updated
- Jun 10, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 62577 | CA | Primary |
Addresses
Primary practice location
18377 Beach Blvd Ste 106B
Huntington Beach, CA 92648-1349
Mailing address
PO Box 28883
Santa Ana, CA 92799-8883
Phone (949) 529-1038
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150709002690 | CA | Order and Referring Only - Dentist | 4880906429 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62577 | CA | MD | Pharmacotherapy Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560124800000",
"number": "1245572619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 28883",
"city": "SANTA ANA",
"state": "CA",
"postal_code": "927998883",
"telephone_number": "949-529-1038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18377 BEACH BLVD STE 106B",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926481349",
"telephone_number": "714-847-8660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZARDOUZ",
"first_name": "DIANA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-22",
"last_updated": "2019-06-10",
"deactivation_date": "2013-06-05",
"reactivation_date": "2014-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62577",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Huntington Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.